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2. First Name*
3. Last Name*
5. Address Line 1*
6. Address Line 2
8. City*
9. State*
10. Zip Code*
12. Email*
13. Phone*
15. Date Leaving*
    Date Leaving
16. Date Returning*
    Date Returning
18. Will you be leaving lights on?

    1. Yes
    2. No
19. If so, where?
21. Will lights be on a timer?

    1. Yes
    2. No
22. Time lights will be activated and light location:
24. List vehicles belonging to you that will be left in driveway:
26. Vehicle Number 1 Year / Make / Model / Color / License Number
28. Vehicle Number 2 Year / Make / Model / Color / License Number
30. Vehicle Number 3 Year / Make / Model / Color / License Number
32. Vehicle Number 4 Year / Make / Model / Color / License Number
34. Phone Number Where We Can Reach You
35. Phone Number of Someone Local We Can Contact
37. List those who will have access to residence, their vehicle description, and reason for entry:
39. Do you have an alarm?

    1. Yes
    2. No
40. Will the alarm be activated?

    1. Yes
    2. No
42. Alarm Company Name
43. Alarm Company Contact Person
45. Alarm Company Account Number
46. Alarm Company Phone Number
48. Can the contact reset the alarm?

    1. Yes
    2. No
50. Special situations of which we need to be aware:
52. I acknowledge I will contact Lynden Police Department if my departure or arrival dates and times change:

    1. Agree
    2. Disagree
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field